Adequacy of post caesarean section pain management at the time of discharge at an academic hospital

Abstract

Introduction Adequate analgesia post caesarean section accelerates ambulation, improves patient outcome, reduces maternal morbidity, and facilitates early infant care. Clinical practise guidelines for post caesarean section pain management, if successfully implemented and adhered to, should improve quality of care and patient pain outcome. Current trends are moving towards earlier discharge of patients post caesarean section. The aim of this study was to determine whether guidelines used for post caesarean section pain management adequately controlled their pain at the time of discharge which was approximately 48 hours postoperatively at Chris Hani Baragwanath Academic Hospital. Method This was a prospective, contextual, descriptive study. Convenience sampling was used and 91 patients were enrolled after informed consent was obtained. At discharge patients pain was measured using a Visual Analogue Scale score and the patients’ pain management was documented. Results The majority of patients, 41 (45.05%), were primiparous, 57 (62.64%) patients had no previous caesarean section and 87 (95.60%) had received spinal anaesthesia. The mean length of stay post caesarean section was 43.48 (SD 7.52) hours, with a minimum of 29 and a maximum of 66 hours. Of the 91 patients, 54 (59.34%) patients had a score <40 mm which was adequate pain control and 37 (40.66%) patients had a score ≥40 mm, which was inadequate pain control. The departmental clinical practice guidelines for post caesarean section pain management were correctly prescribed for all patients; however none of the patients received pain management as recommended by the guidelines. One (1.10%) patient received only 1 dose of omnopon, 23 (25.27%) patients received 2 doses, 65 (71.43%) received 3 doses and 2 (2.20%) received 4 doses. Seven (7.69%) patients received no indomethacin and 13 (14.29%) received no paracetamol. The secondary objective comparing adequacy of pain control with parity was not statistical significant (p=0.8321). Conclusion Pain medication was not given according to the pain management guidelines, even though it was prescribed correctly. At the time of discharge however, more than half of patients had adequate pain control despite receiving less pain medication than recommended by the guidelines. Education regarding pain management could result in patients receiving better pain management.